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Category: Health/Medical

Deal on Payroll Tax, Doc Fix, Unemployment

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Congressional leaders have reached a tentative deal on a payroll tax cut, extend unemployment benefits, and delay rate cuts to doctors who treat Medicare patients.  Under the proposed plan, a 2-percentage point payroll tax cut would be extended until the end of this calendar year.  The cost of this tax cut would be added to the federal deficit. Unemployment benefits would also be extended for the next 10 months and doctors who treat Medicare patients would avoid seeing their payments cut. Those two provisions would cost about $50 billion and be paid for with cuts elsewhere in the federal budget.

One of the most sensitive issues in the final negotiations was the question of how much Medicare should compensate hospitals for the bad debt accumulated when patients don’t provide their required co-pays for care (uncompensated care). Medicare currently compensates hospitals for 70 percent of their loss and the House proposed to cut this to 55 percent — saving more than $10 billion over 10 years. But this puts a heavy burden on hospitals that provide a lot of uncompensated care – like Harborview.  The final compromise lowers the bad debt cut to about $7 billion, which is better than the original proposal from a couple of months ago but it will still be a blow to hospitals with low-income patients.

This Week in Washington DC

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Happy Monday morning!  It will be a busy week in Washington, DC with the continuing resolution (CR) expiring on Friday, appropriators scrambling to approve at least one “mini-bus” before week’s end, the Joint Deficit Reduction Committee deadline looming next week, the House taking action on a balanced budget amendment, and Obama announcing the next phase of his “We Can’t Wait” agenda.

Super Committee

Although the bipartisan panel officially has until November 23rd to make their recommendations, it would take time to write legislative language and have it officially analyzed by the Congressional Budget Office by that deadline, as is required by the August debt limit law (PL 112-25) that created the committee. This means that the group will need to have the outlines of a deal in place by the end of this week.  On a positive note, members of the bipartisan panel have recently indicated their willingness to compromise on issues important to each party – such as increasing revenues and curtailing entitlements. Republicans for the first time have opened the door to an increase in new tax revenue, while Democrats have proposed deeper spending cuts, which could include both Medicare and Medicaid. Despite that progress, both parties rejected proposals leaked last week that contained those concessions, each side saying that the other’s plan had not offered enough.  

First Mini-Bus:  Agriculture, Commerce-Justice-Science, and Transportation-HUD

Appropriators are expected to file a conference report Monday on the first mini-bus of FY12 spending bills, setting the stage for Congress to clear it by week’s end.  The package contains roughly $127.8 billion in discretionary appropriations for the Agriculture, Commerce-Justice-Science, and Transportation-HUD spending bills for FY12.  It is expected to be passed first by the House and then by the Senate.  The largely non-controversial bundle will contain a new CR to keep government running through mid-December, since the current stopgap measure expires on Friday.  

Second Mini-Bus:  Energy-Water, Financial Services, and State-Foreign Operations

The Senate will begin debating the second mini-bus package this week, and hope to take action on the measure next week before leaving for the Thanksgiving holiday.  The package, which includes the Energy-Water, Financial Services, and State-Foreign Operations spending measures, would provide a total of $129.5 billion for the various agencies in FY12.  In a sign of bipartisan support, 81 senators backed cloture on the measure last week but support for bringing the bill to the floor may mask stumbling blocks that lie in controversial amendments, which are expected to target both funding levels and policy provisions in the bills.

Balanced Budget Amendment

House leaders plan to bring up for consideration a balanced budget amendment to the Constitution.  This measure will be a more “traditional” version rather than one that mandates spending caps and requires a supermajority for raising taxes.  Supporters of the traditional balanced-budget amendment, which requires that outlays do not exceed revenues and a three-fifths majority to raise the debt ceiling, emphasize that the same version passed in the House in 1995 with 300 votes, including 72 Democratic supporters. The vote, scheduled for later this week, will fulfill a requirement of the August debt limit law and also satisfy members of the House Republican conference who are eager to back it.  Constitutional amendments require a two-thirds majority to pass either chamber, which is 290 votes in the House and 67 votes in the Senate.

Obama’s “We Can’t Wait” Issue of the Week:  Healthcare Workforce

According to the Washington Post, the Obama administration will announce today as much as $1 billion to hire, train, and deploy healthcare workers, part of the President’s broader “We Can’t Wait” agenda to bolster the economy after his jobs bill stalled in Congress last month.  Grants can go to doctors, community groups, local government, and other organizations that work with patients in federal healthcare programs such as Medicare and Medicaid.  The funds are for experimenting with different ways to expand the healthcare workforce while reducing the cost of delivering care.  There will be an emphasis on speed, with new programs expected to be running within six months of funding.   The Center for Medicare and Medicaid Innovation, created as part of the Affordable Care Act, will administer and oversee the program, called the Health Care Innovation Challenge. 

Sources:  CQ, Washington Post, Politico

NIH and USDA News Today

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Today, the United States Court of Appeals for the District of Columbia Circuit vacated the preliminary injunction entered by the district court and ruled in favor of the National Institutes of Health and the Administration’s policy on human embryonic stem cells (hESCs). The ruling states the following: 

“We conclude the plaintiffs are unlikely to prevail because Dickey-Wicker is ambiguous and the NIH seems reasonably to have concluded that, although Dickey-Wicker bars funding for the destructive act of deriving an ESC [embryonic stem cell] from an embryo, it does not prohibit funding a research project in which an ESC will be used. We therefore vacate the preliminary injunction.”

As you might recall, last August, U.S. District Court Judge Royce Lamberth had ruled in favor of two scientist plaintiffs and issued a preliminary injunction that briefly blocked federally funded embryonic stem cell research on the grounds that NIH’s 2009 hESC guidelines violated Dickey-Wicker. Today’s decision vacating that injunction can be viewed here.   There is still the possibility of an appeal. 

Also in the news today, Dr. Roger Beachy, the current Director of the National Institute of Food and Agriculture (NIFA) at USDA, will resign as Director effective May 20, 2011 to spend more time with his family. In the interim, Dr. Chavonda Jacobs-Young will be named as Acting Director of NIFA.

President’s FY12 Budget Request

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Today, President Obama released a $3.73 trillion budget request for FY12. The White House estimates that the request and projections for spending in the out-years would reduce the deficit by more than $1 trillion over the next decade. Despite reductions in overall spending, the request contains significant increases for research and development as well as some education programs.

National Institutes of Health– $31.8 billion, an increase of 3.3% over the FY10 level of $30.8 billion

White House/Office of Management and Budget HHS FY12 Budget Summary

National Science Foundation– $7.77 billion, an increase of 13% over the FY10 level of $6.87 billion –keeping the agency on track for a 10-year (FY08-FY17) doubling that is authorized in last year’s America COMPETES Act

NSF FY12 Budget Materials

Department of Energy, Office of Science– $5.4 billion, an increase of 10.2% over the FY10 level of $4.9 billion –keeping the agency on track for a 10-year (FY08-FY17) doubling that is authorized in last year’s America COMPETES Act. $550 million is also included for the Advanced Research Projects Agency-Energy (ARPA-E) to continue support for the promising early-stage research projects that could deliver game-changing clean energy technologies.

DoE FY12 Budget Materials

Department of Defense, Science and Technology– $12.2 billion for science and technology programs, which includes a 2% real growth in basic research

National Oceanic and Atmospheric Agency– $5.5 billion, an increase of 14.3% over the FY10 level of $4.85 billion

White House/Office of Management and Budget Department of Commerce FY12 Budget Summary

Department of Education–

  • Continues support for a $5,550 maximum Pell Grant award, $819 above the level in 2008, largely paid for by eliminating the year-round Pell Grant and the in-school interest subsidy for graduate and professional student loans
  • Invests $26.8 billion, an increase of 6.9 percent, in a reformed Elementary and Secondary Education Act (ESEA) focused on raising standards, encouraging innovation, and rewarding success, while allowing States and districts more flexibility to invest resources where they will have the greatest impact. The new ESEA directs funds to reform-oriented competitive initiatives, consolidates dozens of programs, and cuts programs that do not demand results.
  • Provides $1.4 billion for new competitions, modeled on the Race to the Top initiative, to strengthen and reform early childhood education, improve district performance in elementary and secondary education, and improve outcomes in higher education

Department of Education FY12 Budget Materials

National Endowment for the Humanities– $146 million, a decrease of 13% from the FY10 level of $168 million

NEH FY12 Budget Summary

Additional information on President Obama’s FY12 budget request will be posted as it becomes available. The release of the President’s Budget Request (PBR) is the first step in appropriations process for the coming year. After Congress and the President settle on a path forward for FY11 — which began on October 1, 2010 — the FY12 process will begin to move forward.